Dr. R.K. Brisling scrunched his nose at the stench of formaldehyde. Even a whiff of the stuff gave him flashbacks of medical school anatomy class, the ranks of mangled cadavers with their greasy flaps of skin, ropy muscles, and hardened organs. It was as if the chemical had fixed the memories in his brain.

Hanging his white coat in the antechamber, he donned a full-length blue surgical gown, blue booties, hair bonnet, and surgical mask. He stood before the double swinging doors with their little porthole windows, regretting the bologna-and-mustard sandwich he had eaten for lunch. Then he pushed through the doors and entered the autopsy suite.

Bright fluorescent light flooded the spacious room. The smell of formaldehyde was gone, but in its place hung a subtler scent, tangy and unsettling. In the middle of the room were three stainless-steel tables, one set higher than the others. On it lay the pale body of a man, the head propped up with a block of wood. The torso was split from stem to stern, organs removed to steel pans on a side table. Even though a surgical towel covered the man's face, Brisling recognized the matted licks of brown hair.

At the head of the table stood two women in full surgical garb. By their height and their eyes, Brisling knew them both. The tall one with bright blue eyes was Cornelia Hoffman, Medical Examiner. The short one with startled hazel eyes was Anna Jankowsky, Medical Student Number Two. If the girl truly wanted to be a pathologist, Brisling could think of no better way for her to start.

The body on the table belonged to John C. Lundquist, their former patient, the molecular-biology technician who had succumbed to an exquisitely rare brain disease. At least that was the working hypothesis. But the only sure way to diagnose progressive multifocal leukoencephalopathy was to sample a bit of brain tissue, or in Mr. Lundquist's unfortunate case, the whole damn noodle.

"You're just in time," said Cornelia. She laid her long fingers on the towel covering Lundquist's face then peeled it back just far enough to expose a pasty forehead. With a scalpel, she cut a gruesome halo all the way around his skull, just above the ears.

Anna Jankowsky watched on, eyes wide and unblinking. A single tear plopped onto the fabric of her mask, soaking in, and Brisling felt a niggling ache beneath his breastbone. He was about to reach for his nitro tablets when he remembered they were in the pocket of his white coat, hanging in the antechamber.

Jankowsky held the electric bone saw ready. It was a small but evil device, gleaming stainless steel tipped with a serrated cutting disc. The saw buzzed to life, and she positioned its cutting disc near the bloodless incision over Lundquist's left ear, hands trembling. Cornelia leaned over the girl's shoulder, cradled her elbow, and whispered encouragement into her ear. The serrated disc trembled close, slipping past the flesh. But as soon as metal bit bone, that sickening grind, she screeched and let go of the saw. It clattered on the floor and skittered away as far as the cord would allow. Jankowsky turned and fled the room, her blue gown billowing behind her as she pushed through the double doors.

Cornelia shot Brisling a withering stare as she reeled in the bone saw and switched it off.

"What?" said Brisling.

"Anna told me about her experience with you."

"Ah, come on. Someone has to toughen these kids up. Have you seen the way they baby them? All those vacation days? All those nights off. Fatigue awareness training. Jesus. I don't even know what fatigue awareness means."

Cornelia's eyes narrowed.

"What, you think she deserves special treatment because she's a woman, is that it?" asked Brisling.

"No, because she's struggling."

Brisling paused. "I didn't know that."

She took up the bone saw and switched it on. "You didn't ask."

Cutting the skin and calvarium all the way around, she used a T-handled chisel to break through the stubborn bone just above the ears. The top of the skull came loose with a wet sluck. Beneath, gray gyrations glistened under the fluorescent lights.

"Doesn't look that bad," said Brisling.

"Neither does a rotten apple." Freeing the brain, she transferred it to a side table and made several transverse cuts with a long knife. Beneath the glistening gray rind was a gristly core, pocked with tiny holes.

"Is it PML?"

"Could be," said Cornelia as she poked at the holes with a fine probe. "I'll have to look under the microscope before I can say anything for sure."

"Best guess?"

"You know I'm not that kind of girl."

"Come on. What's your gut instinct, off the record?"

"Well, if I ignore this man's medical history, ignore the fact that he was completely healthy and had a normal immune system—had no reason for this to happen—then yes, this looks very much like PML."

Brisling stared in grim silence at the mutilated organ.

"What's wrong?"

"I don't know." He paused. "Déjà vu, I guess."

Late that evening, after midnight, Brisling retired to his basement laboratory. It was not a proper laboratory, but a converted office he had filled with surplus equipment and a few items from his days at the CDC. He worked alone, and mostly at night, isolating bacterial strains and assaying their susceptibility to antibiotics. It was just tinkering really, a soothing hobby to placate his insomnia.

He logged onto his old desktop computer, cracked a can of Pepsi, and streamed the latest episode of Longmire. Realizing he had already seen it, he surfed the news. The top story screamed in red capital letters: "VICE PRESIDENT STONE SUFFERS STROKE." Hardly a surprise. At eighty-four, Albert Stone was the oldest Vice President ever elected. A decorated Korean War vet, Albert Stone's folksy grandpa-warrior shtick had propelled Jack Almerson to the White House.

In other news, the Mariners were still awful, the Seahawks little better. There was another commercial airline disaster, this time a local commuter that had gone down in perfect weather over the Appalachians. The last six months had been the worst on record in the US for transportation-related deaths, up a perplexing one hundred and twenty percent.

Brisling had just bitten into an article predicting a shortage of seasonal flu vaccine when from somewhere beneath the paper detritus of his desk, the phone rang. Not his cell phone, but the landline only administrators called. But at one in the morning? Brushing aside the papers, he picked up the receiver and put it to his ear.

"Brisling here."

"R.K.," said a man's voice. "How are you?"

The silvery New England accent sent a shiver down Brisling's spine. "Who is this?"

"It's me, Joe."

"Joe who?"

"Joe Flaherty."

"Senator Joe Flaherty?"

"That's right, the Massachusetts Messiah."

"Jesus."

"Well, I wouldn't go that far."

"How long has it been? Thirty years?"

"Thirty-four."

"Right." It was 1983. Flaherty had summoned a young Dr. Brisling to serve on a task force investigating the mysterious outbreak of cancer and rare infections among gay men in San Francisco—the first ripple of the AIDS epidemic. "Why the hell are you calling me at one in the morning?"

"Now that's the R.K. I remember. I'll tell you why I'm calling. I need your help again, here in DC."

"What for?"

"It's the vice president."

"Yeah, I just saw the news."

"Not all of it."

Brisling paused. "He's dead, isn't he?"

"I'm afraid so."

"And it wasn't a stroke, was it?"

"No, R.K. It wasn't."

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Image take from http://img.medicalexpo.com/images_me/photo-g/84529-9199650.jpg